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Monday, September 29, 2008

Sorry if this is patronising but I have to explain this to my students so I'm going into Lecturer Mode.

Self-help books:Most parenting guides, and most books on adoption, trauma and the like fall under this heading. To use a health analogy, these are like either a well-written book on cooking for diabetics, or the Atkins guide. Some individuals may like both - may swear by both - but medically, one can be pretty harmful. Just because something is in a book does not mean it's right, or harmless, or based on any evidence. I hope you all know the same is true for web pages. All the authors in the links given fall under this heading except one (see below).

Peer-review:When researchers do independent studies (not funded by an organisation with an axe to grind) they need to publish them. They can publish in a book, which could be either a scientific book (mainly intended for scientists), or in a college textbook (though rarely without publishing elsewhere first), or in a self-help book. They can also publish on a web page - but see above about web pages.

They can write in a scientific manner and include a lot of references to other people's work. But you're I'm sure all acutely aware it's really easy to misquote or selectively quote other people's work.

So unless another researcher has reviewed the first researcher's work, without knowing who they were (to avoid personal bias), then anything even well-known scientists write could be a misquote, could be based on no evidence, or could be based on anecdotes - on just one person (see below). Peer reviewed work has found that children do not suffer from a change of caregiver at birth purely due to the change of caregiver. The nice links that antiadoption gave me were in fact none of them peer reviewed. In fact, one of the authors (Bruce Perry) she links to is also quite a well-respected author who's written a lot of peer-reviewed papers. He writes on trauma due to maltreatment and severe neglect, and its effects on behaviour and on the brain. He has done absolutely no work that I'm aware of on separation at birth and placement with a loving replacement caregiver.

I think we're all in agreement that mothers who are trying to decide whether to place their newborn for adoption have not maltreated their child, nor have they neglected them. If the adoptive parents maltreat their child, this is awful, if a birth parent maltreats their child, this is also awful, but not really relevant to the question of whether separation at birth and continuing care by loving replacement carers is traumatic. As I said in my previous post, I've seen no peer reviewed work with evidence that it is.

Scientific evidence:When one person tells you that blood type eating, propping their legs up, having their bumps read, or regression therapy works for them, you might be a bit sceptical. How do they know they weren't going to get thin/pregnant/sane anyway? The gold standard is to randomly compare different conditions in different groups of people - half in each condition - and see what the outcome is - which group improves more. You can do this with therapies for mental health problems. There is no point in comparing a child on a therapy with themselves before the therapy as children grow, and people get better on their own.

But you can't randomly allocate children to being placed for adoption at birth and not being placed. You can only look at naturally occuring situations. You can look at children who are cared for by relatives and neighbours, not their birth mother. You can look at children whose mother died at birth. You can look at children adopted at birth. And when you have two groups, you can look at what else was different (were the grandparents ill and frail? was the father wrapped up in his new wife? were the adoptive or birth parents unrealistic in their expectations, or overindulgent? was the birth mother a sufferer from mental illness so didn't take care of her health/think she could care for her baby?) and only after you've allowed for that can you conclude that separation at birth hurts children. And there is no evidence that it does.

Remember, boys and girls, if you read it on the web it isn't necessarily true. Hope that didn't shock you too much. Here's a large pinch of salt for you to read both my posts and everything else on the web with.

(An an aside - yes, there is a lot of evidence that adoption is traumatic for the birth mother in particular, though I don't know if anyone's looked at outcomes for the birth father. There is a lot that can be done to help people in this situation - and good and bad practices no doubt exist in a variety of places. A new parent's feelings for a child are usually called bonding rather than attachment, as they operate a bit differently - a lot faster, for a start. Even parents who must give up their child - in some cases, who are legally forced to because they have abused them - bond to their child).

but I feel I should follow through. I'm not going to post any more at the moment on trauma due to separation at birth. I think however I should explain some terms I used in my previous post as I'm not sure commenters have really understood them.

First consider this scenario. You are in your first day at school. Before going to school you knew there would be a teacher and you were told the teacher would be nice and school would be fun. You arrive at school and are waiting in the classroom. Someone puts their head in the door and waves at the class. "Hi!" they say. They leave and then shortly after someone else comes in. "I'm going to be your teacher!" they say. They are very nice and you enjoy school. Later you find that the first person was supposed to be your teacher. But you never knew them - so you didn't have a chance to miss them. You like your new teacher - you end up having the original teacher a few years later and you like them too. Everyone is happy.

If you had been a little child beginning school and had got used to the first teacher, you'd be sad if they left. If the second teacher had been mean, you'd be upset when you found they weren't really supposed to be your teacher. If you were the teacher and you had learned all the information about your class and felt like you knew them, you'd be sad. If you saw the teacher around the school, or met them when you were older, and no-one had told you they were first supposed to be your teacher, you'd be confused. The first teacher at school is a really important person, and children become extremely attached to their teacher, eager to please, and if they are a bad teacher, this really does get children off to a bad start.

But the child who never knew the first teacher - saw them for less than a minute - but has the whole situation explained to them properly, and gets to know the other teacher - is going to do just fine.

Right - that is the anecdotal post. I'm now going to start a new posts explaining some important definitions.

Sunday, September 28, 2008

That was me yesterday before going to the Urgent Care facility with my Bartholin cyst.

OOWWWWWOWWWWWWWWWOOOOOOOOOOWWWWWWOOOOOOOOOOOOWWWWTTHHHSSSSFFFFFFFFFFFFF(that was me yesterday while being "numbed" with lidocaine before having the abscess drained. How do you spell that sound you make while sucking through your teeth?).

They tried to put a catheter in but the gland was quite small (perhaps why it gets blocked) and it just came out. So I may need to have this done again at some point, or have it stitched open.

(Can I just have another OW?)

I now feel much better, you'll be happy to hear. No-one could make me a gynae appointment with New Plan next week as far as I tell, though I'm going to ring back on Monday, and if nothing comes up, go back to Urgent Care.

(Wiki link for the lazy. I have had several cysts in the past and some have become abscesses - this was definitely an abscess).

Woke up early this morning and checked my email. Message from Best Woman who is losing the pregnancy (2nd FET after ICSI, lost the 1st FET, ICSI didn't work). They had seen the heartbeat and then she stopped feeling sick and started spotting at about 10 weeks. Scan on Friday showed no heartbeat. They've decided to "wait and see" but the hospital said come back in 2 weeks if it hasn't completed by then. I'm not sure they gave her enough information (I think I must be lucky in feeling I've had sufficient information at most points during my miscarriages - but then I'm nosy and ask questions like "what would happen in the old days before scans?" and "how come they say most pregnancies fail early when the first 12 weeks are all supposed to be dangerous?") and she said it was actually pretty helpful talking to me.

I'm not sure she realised how unlucky it is to have the pregnancy fail after seeing a heartbeat but I don't know if she would want to have any further investigations about causes of miscarriage - they can only have ICSI until next July, when she is 40, as they can't afford the fresh cycles themselves, so the clock is ticking on treatment and I happen to know the main miscarriage clinic in her area tells you to stop trying to get pregnant while undergoing investigations.

I'm not being lazy, honest, but am a bit blogged/commented out, so will blog a bit more about the comments on my "comment on another comment" post, another time. And very sorry to those who have not had comments returned/those participating in ICLW - have been a bit slack - in my defence, I've been in pain!

I have far too many blogs. I have this one, which doesn't have that much day-to-day stuff on it. I have my original one, a short-but-sweet blog with the odd photo, funny item and thought, some profound, but basically I do not mention this part of my life on there. It's not on blogger (it's on an independent system a friend set up) so it doesn't link in here.

I also have a blog under a different name that is a walk through the saints associated with each day of the church year (there are some gaps, to put it mildly, even though a few friends collaborate) and I have the blog of my 11-year-old diary, which also has a few gaps - though I left the diary itself in the UK so won't be finishing that this year.

My mum knows about the 11-year-old diary but doesn't really "get" blogs. No-one else in the family knows about my blogs except Mr Spouse, who knows this one exists but kindly doesn't read it, and reads the 11-year-old diary when it is updated, and also the independent chatty one, which is also rarely updated.

I would in some ways like to post more about the rest of my life here - it would be more interesting for my regular readers, and for any new readers I get. I have several friends whose blogs I read and for whom I log out as Dr Spouse to post a comment, so they can't see this one. Most would find it very much TMI. You can see this one, but not my other Blogger blogs, on my profile. I'm sure if you looked hard you could find me (though hopefully not under my full name as I removed the only comment with my name - when I became a media tart).

Do you have separate blogs? Who do you tell about your IF blog? Do they care??

Friday, September 26, 2008

This post at Building Heavenly Bridges has made me think what I would like/have liked in a take-home pack from the hospital after having miscarriages 1 and 4 (the others happened at home).

The first time I got a leaflet from The Miscarriage Association, and I believe something that . The second time I got some hospital maxi pads, a compliment on my pyjamas, and a promise to carry out chromosomal analysis on the foetus.

I later got something about the annual church service that is held in my area for those that have lost a baby, which we did go to that year.

Although I've not felt a need to have such things, I know other women have found poems, prayers, and remembrance items such as bracelets to be helpful. I find more therapy in knitting and watching trashy TV. Perhaps women should be given vouchers for DVDs, and suggestions on where to get memorial jewellery. It might be nice to have a memory box or folder, and to be asked if you wanted scan pictures.

I think what I needed most especially in the first weeks and months after the first miscarriage, though, was someone to talk to. There is no local support group in my area, although hundreds of women must miscarry in the area every year (based on the birth rate which I know). There's someone available on the phone once a week at an inconvenient time (I suspect it's before her kids get home from school), about 50 miles away.

Thursday, September 25, 2008

So a couple of weeks ago I was moaning to my doctor friend about having no insurance. "What if you get hit by a bus?" Well, we explained, we are OK if we get hit by a bus, but not if we get stomach flu or a nasty skin condition or need a flu jab or a new prescription for high dose folate or, briefly explaining the last few years, if I get pregnant. Turns out her sister is about 20w with her 5th pregnancy - one living child - factor V Leiden. A lot of it around.

But she pointed out that she knows lots of specialists (although as a psychiatrist it might look odd if she prescribed insulin for Mr Spouse!) and could no doubt find someone for us to see at a slightly reduced cost.

However in double quick time the HMO we had applied to and been rejected for regular coverage has - surprise! - approved us for the expensive, but roughly the same level of coverage, HIPAA plan. Hint for those in dire straits moving from another country - foreign coverage counts under HIPAA. And they didn't even need to check with my GP, so no expensive letter or snooty administrator telling them the wrong things on the phone. So I'm covered from the 1st (only problem - I have a Bartholin cyst recurring now. Ouch. Normally they last 3 days, 2 of which are a weekend, and so I never get them seen. This one's been about 5 days - I'm torn between hoping it goes away tomorrow and hoping it lasts long enough to be seen by the doc - not too sure I'd even get an appointment before the 1st anyway!)

Wednesday, September 24, 2008

Because I can't! Apparently I called my mother "mommy" for the first two years of my life (as that's what she called herself) but then went to nursery and it became Mummy, and then later Mum, though it's switched back, but I refer to her as "my mum" or "my mother".

In US English the vowel sounds in "cot" and "caught" are the same - so words that are spelled as if they should be pronounced with a short /o/* are actually pronounced with more of an /a/. The sound isn't, however, quite like the British English "caught" so, as I notice that kind of thing, I notice that when I try to say "mommy" I don't sound like Americans do when they say the word. There are about 15 vowels in US English and 20 in British English, if you are interested. Unfortunately it doesn't make the job of learning to read or spell easier for US children as the phoneme**/grapheme*** correspondence is no more direct.

Since my mother gave up being Mommy quite some time ago, this wouldn't be a problem - if it weren't for the (no doubt annoying to mothers) habit of professionals who work with children of referring to the mother of the child as Mommy/Mummy. "Give it to Mum, now". "Let's see which doll Mummy has!". "Mummy, could you just open the box and show her what's inside?". I'm sure this grates just as much as "Ooh, you mustn't do X, it's bad for Baby". So shoot me, I can't always remember Mummy's name in the thick of a session. And you do need to use it to tell the child what to do: "Can you sit on Mummy's lap now and watch the pictures?".

So if you come across some confused children in this part of the world, it's probably because I'm getting involved in some assessment sessions with them...

If anyone knows of a way to track comments you have written - at least through Blogger - I'd be happy to hear about it. Just realised I commented on at least two of these already, not that it's bad but just like to spread it around!

*letters between slash marks = individual sounds in words, for the uninitiated.**speech sound, which can be spelled with more than one letter***representation of speech sound in letters, which can be more than one letter e.g. TH is just one sound, so is AW, and so is A_E as in GAME.

Tuesday, September 23, 2008

So as not to carry on another discussion in the comments section at Henry Street - I know Rachel doesn't really want to have more discussion on this...

The premise of the Primal Wound is, as I understand it, that separation from the birth mother is intrinsically traumatic, whatever age it happens at.

All the evidence from studies of child development is that it is not particularly traumatic for children to be separated from their main caregiver when this happens early enough - before they have time to form an attachment. Leaving unsubstantiated theory aside, attachment occurs at around 6-9 months of age. Before this age, babies view caregivers relatively equally - carers that are more sensitive to their needs are preferred, but babies do not seem to experience a feeling of loss when the caregivers leave, either temporarily or permanently, so long as another sensitive caregiver is present. This makes sense in evolutionary terms (according to attachment theorists) because even in relatively recent evolutionary history infants might well lose their mothers at or around birth. In most societies in the world, infants are cared for by many caregivers in the first year of life - in some an older child or grandmother is the main caregiver right from the start - and major psychological trauma isn't exactly prevalent everywhere that infants are cared for in this way.

Of course adoption can be handled badly, and can also occur after infants have had time to attach to their mothers or primary caregivers. But as many have commented (see emory2001's eloquent review on Amazon), things can turn out badly in birth families too. Adoption can be bad. It can lead to trauma. Overly high expectations, not explaining adoption, making children think they were not loved, having them live in fear of being given away again, negative portrayals of birth parents or lack of contact or information that the child is ready for - obviously these are all bad, and are likely to occur only when children are adopted - though very similar things occur following acrimonious divorces with sole custody by an aggrieved parent. Also bad is telling a child they are the ultimate in an amazing genetic line, that the first-born always has to be a doctor, that they need to carry on the family line. These are only going to occur in biologically related families.

I don't believe it's the trauma of separation at birth that causes problems in adoptive families. Adoption is a special situation, in that it is unusual (in many societies children are not raised by both their biological parents, but it is usually either a step-parent plus one biological parent, or a biological relative). It therefore needs special handling, and only special parents can really do it. But you'll find that academic researchers (those who publish in peer-reviewed journals - not those who publish non-academic books) do not agree that change of caregiver at birth is intrinsically traumatic. See, for example, if you are into that kind of thing, Adoption Losses: Naturally Occurring or Socially Constructed IG Leon - Child Development, 2002, from which I quote:

"No empirical evidence documents the formation of attachment prepartum or immediately postpartum. Although selective responsiveness to early, familiar stimuli may begin at birth (Schechter, 2000), regarding this selective responsiveness as the continuation of a prenatal attachment by the newborn violates empirical data documenting attachments that have been formed not due to consanguinity or prepartum experience, but via repeated, mutual interactions of nurturance provided by caregiver to infant during the first months of life (Bowlby, 1969; Karan, 1994)"

Feel free to comment here - I don't tend to respond to comments, laziness I think really, but unless the discussion gets nasty I'll be leaving it open.

Returned a comment made on the 23rd by Elusive BFP(That was actually returned on the 24th and I don't think I made 5 comments on the 23rd - slacker! But to be fair all my comments on the 23rd were either non-ICLW people, or were returns of my comments, or don't have a link to their blog!)

Monday, September 22, 2008

We decided to explore on Saturday by taking a walk with a Sierra Club local chapter. We don't have an exact equivalent in the UK but the Ramblers are close. I had been in contact somehow with the Sierra Club before (to be honest, I don't think I ever went on any walks with them - I wonder if a friend was a member or something) and my impression was they were younger and more environmentally active than the Ramblers. Their list of local walks is quite similar though - some that are very much too long and hilly for us, and some that are weekday daytime, implying they have some retired and very active members.

This was a 3-mile stroll through some local canyons, though, followed by a short history tour - perfect. Except when we got there we found it was actually a walk of the Singles group! So, not exactly appropriate for this married couple. We were even asked (jokingly, we hope) to tell people if anyone there was married "to avoid misunderstandings". Though not having immediately and publicly come out as married may not be the only reason someone asked Mr Spouse if I was his daughter. I suppose I should be flattered I look young... But normally people say he looks young too.

The local Sierra Club chapter has a "20s-30s singles" group and this, more general, singles group. I suspect the 20s-30s is stretched a bit, unless there are actually no members at all in their 40s, as I was by far the youngest person in this particular group. Then it has a family group. I am not entirely sure if there are walks that are not associated with a particular sub-group. It seems that once one is married or attached, particularly if one is in ones 40s, one is supposed to have a family. Unless their definition of "family" means "partner and self", this means one is supposed to have children.

I am wondering, however, if the family group might not suit us anyway. Less likely to be walking really far, more likely to be walking at weekends, and more likely to be our age(s). If I were single I might try and muscle in on the 20s-30s group and if it were just Mr Spouse I think they'd probably think he was weird if he wanted to go to the family group, but a childless couple might be welcome. But I'm not completely sure about that - when I was in my 30s and Mr Spouse was in his 40s we were told we couldn't go to the (non-singles) 20s/30s Ramblers group locally because he was too old. Although people's kids (under 20) were allowed...

Sunday, September 21, 2008

The problem with this IComLeaveWe is that I'm going to actually have to write some posts for people to comment on, aren't I?

Annoying holiday couple aka Mr Spouse's best man and wife are due to have their (very much waited for and conceived without intervention but after many many investigations) baby in four weeks' time. Mrs AHC is on maternity leave already but this is partly as she had a secondment from work in a different town which just ended so there seemed little point in going back to the regular job. Apparently the baby "is already 6lb 7" so they think "it's going to come early". No, dear, it's going to come at about 42w and is going to be 10lb. Am I allowed to tell her that? And that labour will be horrendous?

S & J aka my best woman and husband also have happy news - they should be 9w pregnant by now from a 2nd FET following a failed ICSI and an early miscarraige - well, last weekend they were 8w and they had seen the heartbeat at 6w so, given they don't have my horrendous history, I'm confident things will be well for them.

So I can think of a couple more things to say but I'll eke them out into another post, I think, so I have more for people to comment on!

Monday, September 15, 2008

This was going to get quite long to be a reply to a comment on someone else's post so I decided to make my own new post replying to a comment by Michelle on a post over at Henry Street.

Michelle says "What's interesting is how people try to conceive a child naturally, can't, then choose the adoption route."

I know that this is true for many families, that biological conception the "regular" way is their first choice, then adoption is only considered after at least that one option has been exhausted. Some will never even seek a diagnosis or investigations for infertility before going for adoption, although they will have tried to give birth but will not. Some, however, do choose adoption first - some are single parents, some are same-sex couples, some feel a very strong desire to adopt (and some of these go through foster care adoption, though some feel a really strong desire to adopt from a specific overseas country, or to go through domestic adoption), and some do have one or more biological children and have no infertility issues but feel that adoption is right to complete their family. Since adoption is about the child not the parents then there is a significant minority of parents who feel that bringing a new child into the world, rather than giving a home to a child who needs one, is not right for them.

But even looking at just heterosexual couples who have experienced fertility issues, the main reason I feel why people first try to conceive and then decide to adopt is that adoption is relatively speaking, extremely rare. Adults of my generation will know adopted peers but I know very few families who have adopted - and some of them I only know because we're investigating adoption. Some couples may have a strong bias towards genetic children - some though may even feel they don't want to have genetic children because of an inherited disease or because pregnancy presents a very specific health risk to the female partner. But finding families who have adopted, and adoption being a normal part of life, is just not where we are in the West, so it's not on many people's radar.

And it's also, completely rightly so, very hard to do. Adoption is about finding a family for a child who needs one - perhaps reproduction should be harder for most people, but good luck to anyone who tries to legislate that.

My take is that people go with the easiest option that they know most about (the one involving two adults who love each other very much...) and then if that fails, they move to an option that's acceptable for them and accessible to them. IVF, for example, is not acceptable to everyone, and not accessible to some either - I think more couples in the UK skip IVF as paying for medical care is not possible, or even on the radar, for a lot of people, and not everyone can get it paid for, while foster care adoption is free. People who choose adoption early, or even first, are often those who know about it first hand, from their extended family.

I have even heard about families who've been asked why they didn't consider IVF or some other form of ART if they are adopting - and some odd attitudes from social workers for couples who choose adoption either as their first choice or if they are not infertile (e.g. to add to or complete a family).

Saturday, September 13, 2008

Another conversation with another clueless health insurance employee - they lost my previous backup application, and now if they take me on the backup plan it might not be till November?? NOVEMBER! I'm seeing my nice doctor friend tonight to hopefully she'll talk me down.

So just browsing other blogs this morning, came across this. I am a regular reader of this blog, no idea why, except that there are often educational toys and children's literature on, which are kind of relevant to work, or perhaps it's that I'm a masochist. Anyway the little changing table has a little Snowy on it and we have one because Mr Spouse is obsessed (and we had to leave him - Snowy, that is, not Mr Spouse - in England). And I want a changing table to put Snowy on.

Friday, September 12, 2008

My GP's surgery in the UK wants £98 to write a letter about my medical history. Nearly $200. In advance, natch. If I was sure this would get me on to the plan I originally applied for, it would be worth it, as the secondary plan is about $200 per month more than the original plan. The benefits are similar (I'd rather have Better Plan from Other Company which is the same as the secondary plan in price but more extensive in coverage, but doubt I'd be accepted for that if I wasn't accepted for First Plan).

The receptionist was really snooty in her email, too, basically telling me there was no point in bothering (how does she know? has she tried?).

Wednesday, September 10, 2008

Last night I got a notification that my application for health insurance was declined - with one of the only HMOs that will take me and Mr. Spouse - at least officially, though we may be able to persuade one of the others that he actually has an SSN when he doesn't really. I genuinely thought I would be OK as the only things I had to answer "yes, in the last five years" to on the application were about "female reproductive disorders or painful menstrual periods" and "other". There's no specific question about pregnancy or complications and I didn't think they could deny coverage based just on that question - I thought they'd ask for more information - and the "other" is migraines every second month, approx*.

But apparently these are both problems - and so is my BMI of just over 28 now (this is after losing 35lb which, again, there was no space to elaborate). I may get HIPAA coverage (switch off now if you are lucky enough not to care) as government coverage, even non-US government coverage, counts for this. But I was really, really upset and I'm not entirely sure why. I think it is because I strongly feel the need for a sympathetic, continuous medical presence in my life, even if it's just to go and be told "yes, you have a nasty rash, go away and put calamine lotion on it", or similar, every couple of months. The thing about recurrent miscarriage is that sympathetic continuous medical care is the only treatment, and this probably being due to the placebo effect makes no difference to its effectiveness. The placebo effect still works if you know it's a placebo. And I'm being denied even the placebo.

I'm not entirely sure if this is a serious, unappealable refusal, or if it's routine just to refuse in order to stall, and they expect everyone to come forward with medical evidence and then they'll accept most people. I'm going to try, anyway, and we'll apply to the second insurance company in the hopes they won't notice the lack of SSN.

*Thanks to whoever suggested acupuncture, I've tried it and it improved them but didn't get rid of them entirely.

Monday, September 01, 2008

Just before setting off for SoCal I remembered that we had not yet given our Christmas donation to the Miscarriage Association - a substitute for Christmas cards, and in some ways a way of coming out to some family and friends who did not know what we'd been through. Oops. So I quickly logged on and sorted that out. I noticed they had a few leaflets on their site that hadn't been there before. One is called "When the trying stops" and I found it quite affecting.

Some couples' stories included fostering or adoption and some deciding to live without children. One sentence struck me - "some couples choose to move house". Although we have not moved permanently, and I don't necessarily feel either that we bought a big house to put children in it, nor that we have now moved to a house which is a "couple" house, I think I'm really appreciating the change of scene. It's partly the weather (we've had a not-so-great summer in the UK, and we're in a lovely coastal location here with nice but not too hot weather), and partly the feeling that I'm still on holiday (we've been here less than a week, and it's Labor Day today so I'm not in the office, and we went to a family wedding yesterday).

But I think it is the sense of a fresh start, that we are here for long enough to make a decent go of settling in, the release from (some) obligations. I definitely still feel even more petrified than normal of being pregnant, worried about healthcare, but I also feel somewhat free. It's a bit drastic, but a move of a few thousand miles with 5 suitcases between two of you is to be recommended.